How to help your patients overcome dental phobia

Every dentist experiences this on an almost daily basis – the terrified patient who cannot relax, no matter how well you explain that you’re not in the torture business. It’s a problem that knows no borders. Researchers in Jaipur, India, studied the fear and annoyance that the sound of dental drills causes in patients. A study of Brazilian women tied their anxiety level to socioeconomic factors. Dentists in Turkey, Singapore, and the U.K. have all tried to determine what clothing will be most comforting to their pediatric patients.

So how can we best soothe nervous patients? Let’s take a closer look at the problem and some possible solutions.



Understanding dental phobias

At the most basic level, letting a stranger put his or her fingers in one’s mouth does not come naturally. It goes against our survival mechanisms to allow access to sensitive gums and vulnerable airways. But people also suffer from more specific types of dentist-related fears, called dentophobia or odontophobia. Some patients are afraid of needles, while the drill freaks out others. They might also fear gagging and choking, or pain.

If patients confide in you about their anxiety – which will probably be all too apparent to you anyway – take a moment to try to understand what they’re afraid of. This will help you figure out the best way to help your patients cope. Many will feel more relaxed simply because you care enough to ask. This will make you seem more human, and less like somebody who graduated from dental school just to get some sadistic jollies.

Appearance

What to wear can be tricky, especially if you see patients of all ages. Studies of what attire puts children at ease have had mixed and surprising results. In a study in Singapore published in a 2014 issue of the European Archives of Pediatric Dentistry, both children and parents preferred that dentist wear personal protective equipment. The Singaporean children and those in a U.K. study favored informally dressed dentists, while children in a Turkish study chose formal.

Gender and ethnicity also play a part in patient comfort. The children in the Singapore study preferred dentists of their own gender and ethnicity. Parents chose young female dentists of the same ethnicity. The U.K. study also found that children were more comfortable with a dentist of their own gender.

While you can’t do much about your ethnicity and gender, you can tailor your clothing to your clientele. These studies also suggest that having both male and female dentists on staff could be good for business.

Encourage parents to be good dental role models

With all the things going against us in our efforts to calm patients – pain, noisy drills, needles – the last thing we need is for parents to pass their dental fears on to their children. But this fear was probably passed down to them from their parents, and down the line, back to when their forefathers had one relative designated as the “family tooth puller.” Now that was painful!

So how do we raise fearless – or at least less fearful – little patients? Inform new parents about the importance of starting dental care early. Encourage them to try hard not to share their dental fears with their children. A Spanish study published in a 2014 issue of the International Journal of Paediatric Dentistry found that fathers’ fears of dentistry had an especially strong impact on children.

Promote self care

Practice helping your patients help themselves. Reassure them that all they need to do is give you a signal if they need more Novocain. Encourage your patients to close their eyes, put on headphones, and listen to whatever music calms them. Tell them to go ahead and zone out; you’ll squeeze their hand if you need to get their attention.

If new patients call to schedule appointments but seem to have severe dental phobia, have your staff invite them in for a scaled back getting-to-know-you appointment. Develop rapport, and they may become regular patients. Either way, by helping patients overcome their fears, you’ll have done your part for the greater good of humanity – or at least for humanity’s dental health.



Source: http://www.dentistryiq.com/articles/2014/07/how-to-help-your-patients-overcome-dental-phobia.html



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from paul_fjeldsted http://paul-fjeldsted.livejournal.com/26342.html

Blood, Guilt, and the Roots of Dental Dread

In his foundational 1728 text Le Chirurgien Dentiste (roughly, “The surgical dentist”), Pierre Fauchard laid out a lot of the basis for modern dentistry, including dispelling the persistent belief that cavities were caused by worms (he rightly fingered sugar as a significant factor) and demonstrating that you could affect the growth and alignment of teeth with wire braces (it wasn’t widely accepted at the time that teeth had roots, much less malleable ones).



More than just a technician, though, he also had a host of recommendations for dealing with patients, who tended to be somewhat nervous in the clutches of relatively primitive dentists, who were often as not either barbers (which at the time was essentially a surgeon with a specialization in removing problem areas from people) or charlatans. Probably his biggest piece of advice was that patients should be laid on a raised platform, with an overhead light and the dentist standing or sitting behind them to work. It was a fairly serious improvement over the accepted practice of lying on the floor with the dentist sitting on your chest, your head between his knees, useful as that was for the relatively common practice of tooth removal.



Like most of his recommendations, though, easing the nerves of patients was also considerably ahead of its time. Among professionals, even professionals whose job it is to repair and align our endlessly decaying bodies, no one engenders fear quite like dentists. By some estimates, as much as 75 percent of the population has at least a mild discomfort about dentists; somewhere between 20 and 25 percent have severe enough anxiety that they need to be lightly drugged to make it through a session; anywhere between five and ten have such a paralyzing fear they avoid dental care at all costs, which pretty much means neglecting to go in until and unless their teeth hurt so much they can’t even get through their day. I, for instance, fall into the category of people who will occasionally show up if they’re promised drugs, but I suffered through more than a year of wisdom tooth eruption with some help from Anbesol, a baby’s teething ring, and a fastidious recycling of reminder postcards, in the belief that they wouldn’t try to remove them once they had grown in.



We tend to think of our teeth as mostly a cosmetic concern, and that’s a not inconsequential aspect of dentistry: on forums devoted to dental phobia, you will occasionally encounter people who dismiss dentists as arms of the personal-hygiene-industrial complex, i.e. just another person trying to shame you into buying something to cover up your hideous, smelly, unattractive body. But inadequate dental care can actually have some semi-serious consequences, from your more obvious risks like oral cancer and jaw problems, to links to inflammatory diseases of the body (most notably arthritis), and a still-under-debate correlation with heart disease: dentists will point out studies have shown that people with gum disease are almost twice as likely to have problems with their coronary arteries, whereas heart associations suggest that the connection might just be a coincidence and tell you to exercise.



Not that any further complications are particularly convincing to people who see tooth scrapers as medieval instruments of torture. Of course, most dental tools are Enlightenment-era instruments of torture at absolute worst (Fauchard all but bragged about borrowing tools from jewellers and watch-makers), although the official history pushed by most dental professional organizations almost inevitably includes some reference to Hammurabi’s Code, the ancient Babylonian system of law, which included tooth extraction as a form of punishment. They also frequently mention Saint Apollonia, the patron saint of dentistry, a Christian martyr whose punishment supposedly involved having every last one of her teeth violently removed, although some of them might have just been shattered while they were still in her mouth. So that lesson about assuaging patients’ nerves may not have entirely sunk in.



Most people’s fears have less to do with the cultural history of dentistry, though, than their own personal history. Sometimes that just means they’ve seen Marathon Man (I’m told the dental torture scene is quite gruesome, but I’m pretty much incapable of watching past the shot of the dental instruments), but usually it has to do with a bad experience in their past. Occasionally that means a botched procedure of some kind—true to the fascination of fear, people supposedly terrified of dentists can and do recount these experiences at some length while explaining their current discomfort, though you’re on your own if want more specifics—but shame tends to be just as powerful a progenitor of dread. Phobics are not the most fabulously reliable self-reporters, but studies have suggested that up to half of even serious phobics, and more among the merely uncomfortable, have experienced nothing more traumatic than a dentist being a weapons-grade dick about how often they floss.



This is actually kind of a double-edged sword for dentists, insomuch as the longer you go without professional care, generally, the worse things get, and attempts to correct the behaviour can often just inflame the insecurity and fear. There are ways of getting you into the chair—most dentists are happy to provide either laughing gas or anti-anxiety medication, and some even specialize in just knocking you right out even for routine cleanings—but there isn’t really a way to make you floss regularly or show up ever again (at least if you’re only a dentist: cognitive behavioural therapy has been shown to be fairly effective, but even getting started on that tends to require a first visit, so you can see how this is something of a whirlpool).



About the only saving grace to any of this is that, on the whole, people’s fear of dentists tends to decrease while they age. Although, going back to that shame thing, children are as a group less afraid of the dentist than middle-aged adults; it’s only once you start to reach retirement age that your fears begin to lessen. This is generally attributed to successful outside intervention, and the fact that repeated exposure reveals that dentists (especially ones who know you’re nervous) aren’t really the inhuman monsters of phobics’ nightmares, but it behooves the phobic in me to also point out that no one really judges seniors for having entirely false teeth.



Source: http://www.randomhouse.ca/hazlitt/blog/blood-guilt-and-roots-dental-dread



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from paul_fjeldsted http://paul-fjeldsted.livejournal.com/25964.html

California Removes Outdated Mental Health Terms From Laws

SACRAMENTO (AP) Governor Jerry Brown has signed a bill that deletes from most California laws outdated terms once used to describe mental health conditions.



AB1847 by Democratic Assemblyman Wesley Chesbro of Arcata replaces references to insane, mentally disordered or defective persons with references to mental health disorders, intellectual disability or developmental disability.



Chesbro says using such outdated terms increases the stigma against people who suffer from mental health issues and puts the focus on the disability rather than the person. Previous legislation already replaced references to imbeciles and lunatics in state laws.



The legislation that Brown announced signing Friday does not apply to penal codes used in legal proceedings. Terms such as insane have specific meanings in criminal law and are used in determining sentences.



Source: http://blogs.kqed.org/newsfix/2014/07/18/california-law-mental-health-terms



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from paul_fjeldsted http://paul-fjeldsted.livejournal.com/25663.html

Eating habits of the nation worrying oral health charity

A new look into the nation’s dietary habits has left an oral health charity calling for people to think about the impact their diet can have on their oral health.



The call comes as the findings showed almost three in four ignore the impact diet could have on their oral health when consuming food and drink, with men ranked as the worst offenders.



The results also appeared to suggest nearly a third are unaware of the relationship between diet and oral health, and are oblivious as to the potential damage sugary foods and drinks can cause.



Chief Executive of the British Dental Health Foundation, Dr Nigel Carter OBE, is concerned about the lack of education surrounding diet and oral health and says it is important that people take more responsible with the food and drink they consume while encouraging healthy eating habits, especially in children of a younger age.



Dr Carter says: “Most of us know and understand how various foods and drinks affect our body and overall health but many remain unaware that diet also plays a vital role in oral health. Poor diet contributes to a variety of problems in the mouth including dental decay, erosion and bad breath.



“Every time we eat or drink anything sugary, teeth are under attack for up to one hour. Saliva plays a major role in neutralising acid in the mouth, and it takes up to an hour for that to happen. If sweetened foods and drinks are constantly being eaten, the mouth is constantly under attack and does not get the chance to recover. That is why one of our key messages is to cut down on how often you have sugary foods and drinks.



“Frequent consumption of sugary foods and drinks naturally weakens the enamel on the teeth, and as a result we recommend eating three square meals a day instead of having seven to ten ‘snack attacks'.”



The UK in general has developed a very unhealthy food environment, with more than 60 per cent of adults classed as overweight or obese. This is contributing to a growing social and economic burden of chronic disease including cardiovascular disease and type II diabetes. Both of these killers have also been linked to poor oral health , and Dr Carter offered some simple advice on how people can help their waistbands and oral health.



“If you do snack between meals, choose foods and drinks that do not contain sugar, such as cheese, breadsticks, raw vegetables or nuts. It is better, particularly for children, to eat sugary foods all together at mealtimes rather than to spread eating them out over a few hours. More than one in four five-year-olds suffer from tooth decay, so there is a very real need for parents to moderate their child's snacking on sweet foods and drinks. Try and keep to three meals a day and no more than two snacks.



“It is also worth bearing in mind the Foundation's messages. Brushing your teeth for two minutes twice a day using a fluoride toothpaste and visiting the dentist regularly, as often as they recommend will help to reduce and identify oral health problems . By following this advice we can create a swift improvement in oral health while decreasing the amount of totally preventable dental treatment that is carried out every year.”



Source: http://www.femalefirst.co.uk/health/eating-habits-worrying-oral-health-charity-505039.html



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from paul_fjeldsted http://paul-fjeldsted.livejournal.com/25457.html

NYU College of Dentistry and University of California San Francisco researchers develop a framework

Each year, approximately 22,000 Americans are diagnosed with oral cancer. The five-year survival rate of 40% in the U.S. is one of the lowest of the major cancers, and it has not improved in the past 40 years. More people die each year in the U.S. from oral cancer than from melanoma, cervical, or ovarian cancer. Worldwide, the incidence of oral cancer is increasing, particularly among young people and women, with an estimated 350,000 – 400,000 new cases diagnosed each year.

“The major risk factors, tobacco and alcohol use, alone cannot explain the changes in incidence because oral cancer also commonly occurs in patients without a history of tobacco or alcohol exposure,” said Dr. Brian Schmidt, professor of oral and maxillofacial surgery and director of the Bluestone Center for Clinical Research at the NYU College of Dentistry (NYUCD).

Changes in the microbial community are commonly associated with dental diseases, such as periodontal disease, which is most likely a poly-microbial disease characterized by outgrowth of certain pathologic organisms, as well as chronic periodontitis, which has been reported to be a risk factor for oral premalignant lesions and cancers.

“We know that other cancers, including gallbladder, colon, lung, and prostate, have been associated with particular bacterial infections, so we hypothesized that shifts in the composition of the normal oral cavity microbiome could be promoters or causes of oral cancer,” said Dr. Albertson.

Drs. Schmidt and Albertson and their team profiled cancers and anatomically matched contralateral normal tissue from the same patient by sequencing 16S rDNA hypervariable region amplicons. The team’s findings begin to develop a framework for exploiting the oral microbiome for the monitoring of oral cancer development, progression, and recurrence.

[Note: The team's findings, "Changes in abundance of oral microbiota associated with oral cancer," were published in the June 2, 2014 issue of the online journal, PLOS ONE.]

In cancer samples from both a discovery (n=5) and a subsequent confirmation cohort (n=10), abundance of Firmicutes (especially Streptococcus) and Actinobacteria (especially Rothia) were significantly decreased relative to contralateral normal samples from the same patient. Significant decreases in abundance of these phyla were observed for pre-cancers but not when comparing samples from contralateral sites, such as the tongue and the floor of the mouth, from healthy individuals. Using differences in abundance of the genera Actinomyces, Rothia, Streptococcus, and Fusobacterium, the team was able to separate most cancer samples from pre-cancer and normal samples.

“The oral cavity offers a relatively unique opportunity to screen at-risk individuals for [oral] cancer because the lesions can be seen, and as we found, the shift in the microbiome of the cancer and pre‑cancer lesions, compared to anatomically matched clinically normal tissue from the same individual, can be detected in non‑invasively collected swab samples.” said Dr. Schmidt.

Non-invasively sampling the microbiome of oral lesions and corresponding normal tissue opens the possibility not only to detect cancer‑associated changes at one time point, but the relative stability of the adult oral microbiome also offers the opportunity to monitor shifts in bacterial communities over time.

“Here we observed changes in the microbiome, which, in future larger studies, may be confirmed as a potential biomarker of oral cancers or pre‑cancers and may even have utility for discriminating patients with lymph node metastases,” notes Dr. Albertson. “In addition, there are other challenges in clinical management of oral cancers that would benefit from better diagnostic tools.”

Oral cancer patients are also at risk of second primary cancers and recurrences. The microbiome may provide signatures that can be used as biomarkers for monitoring field changes associated with the high rate of second primary oral cancers and recurrences. The team also notes the possibility of medically modulating the oral microbiome for treatment of oral pre-cancers and damaged fields (field cancerization).

About the Bluestone Center for Clinical Research

The Bluestone Center for Clinical Research, in conjunction with the NYU Oral Cancer Center, is an academic research organization located at the NYU College of Dentistry. Bluestone’s mission is to take a creative scientific approach to transform world health. Bluestone is dedicated to conducting research in oral cancer, cancer symptomology, pharmaceuticals, medical devices, emerging biotechnology, periodontics, implants, and oral health products.

About UC San Francisco

UC San Francisco (UCSF), now celebrating the 150th anniversary of its founding, is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing, and pharmacy, a graduate division with nationally-renowned programs in basic, biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. Please visit ucsf.edu for more information.

About New York University College of Dentistry

New York University College of Dentistry (NYUCD) is the third oldest and the largest dental school in the U.S., educating more than 8 percent of all dentists. NYUCD has a significant global reach and provides a level of national and international diversity among its students that is unmatched by any other dental school. For more information, please visit nyu.edu/dental.



Source: http://www.dentistryiq.com/articles/2014/06/nyu-college-of-dentistry-and-university-of-california-san-francisco-researchers-develop-a-framework-for-monitoring-oral-cancer-development-progression-and-recurrence.html



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from paul_fjeldsted http://paul-fjeldsted.livejournal.com/25119.html

Local anesthesia options during dental hygiene care

Answers to common questions about pain control in the hygiene operatory

By Demetra D. Logothetis, RDH, MS, and Margaret J. Fehrenbach, RDH, MS



Options always exist in executing dental hygiene care, including the administration of local anesthesia. But smart dental hygiene practitioners look to evidence-based outcomes for providing successful care to their patients.

Lately, certain questions have been circulating about some of the options for local anesthesia administration that need to be considered in this bright light. This article with its open-question format endeavors to shed some understanding to these concerns by looking closely at the latest evidence surrounding local anesthesia and its administration.



Lately I have noticed there is discussion about using the maximum dosages from the manufacturers with some agents rather than the lower traditional ones I am accustomed to using, and that are published in most textbooks. How does this affect my practice of dental hygiene?



Each drug has a maximum recommended dose (MRD), including local anesthetics and vasoconstrictors, which are determined by the manufacturer based on results from animal and human studies, with review and approval by the U.S. Food and Drug Administration (FDA). The maximum doses determined by the manufacturer have been reviewed by the Council on Dental Therapeutics of the American Dental Association and the United States Pharmacopeial (USP) Convention.

Maximum doses for many of the local anesthetics have been modified by experts in the field and represent the more conservative of those recommended by the Council, the USP, or the drug's manufacturer. These conservative doses have been published in most textbooks, and have been traditionally taught in many dental hygiene programs across the country.1,2 The MRD for a local anesthetic or vasoconstrictor is defined as the highest amount of an anesthetic drug that can be safely administered without complication to a patient while maintaining its efficacy.

Recently, discussions suggest eliminating the conservative dose recommended by experts in the field, and only utilizing the FDA-approved higher dosing guidelines. This has caused some confusion among dental hygiene educators, as well as dental hygiene practitioners. Questions regarding why this change is being made and how it affects the practice of dental hygiene are currently being discussed.

These dosage levels need to be considered by the dental hygienist prior to the administration of local anesthesia. Over the last 30 years, experts in the dental field have offered lower and more conservative doses that have been successfully used by dental practitioners.1 Each practitioner should determine which recommendation to follow -- the FDA guidelines or the more conservative guidelines that have traditionally been used.

There is added benefit to using the conservative guidelines because it provides additional patient safety while maintaining patient comfort. Fortunately, maximum doses are unlikely to be reached for most dental hygiene procedures. If the dental hygiene care plan involves nonsurgical periodontal therapy (NSPT) for a quadrant, the administration of one to two cartridges often suffices. There is seldom a need to administer more than four cartridges during any appointment involving dental hygiene care.3

Before proceeding with pain control, the dental hygienist must decide which dose is the specific appropriate level based on the treatment to be delivered, as well as the health status of the patient. Thus, MRDs should be adjusted to consider the patient's overall health and any mitigating medical factors that could hamper the patient's recovery.1-3 These amounts are determined based on maximum dosage for each appointment.

The dosage calculation is based on the patient's weight, and can be calculated based on milligrams per pound (mg/lb) or milligrams per kilogram (mg/kg). However, to increase patient safety during the administration of local anesthetics and vasoconstrictors, the dental hygienist should always administer the lowest clinically effective dose.






Figure 1: Insertion of the needle during a posterior superior alveolar block. If the needle is overinserted, it can penetrate the pterygoid plexus of the veins and maxillary artery, which may lead to the complication of a hematoma. Varying the depth of the needle in the tissue to avoid this complication is an option for the dental hygiene clinician.



I am a student dental hygienist. How do all these different local anesthetic dosing guidelines affect my board examinations?



As a student dental hygienist, it is important to thoroughly review the candidate guide before taking any written or clinical examination. The candidate guide will inform you of the information you need to successfully pass the examination.

In the past, most board examinations have tested students on the more traditional, conservative dosages. Some board examination agencies have recently changed their dosage guidelines to reflect the FDA guidelines rather than the conservative guidelines, while other agencies have not.

Therefore, students may need to learn both sets of dosing guidelines, and use the appropriate guidelines for the examination they will be taking. If unsure which guidelines an examination will be testing you on, contact the examination agency for clarification.



Is there any real benefit to using anesthetic buffering in my practice of dental hygiene?



Dental hygienists have the unique responsibility and opportunity to alleviate pain. Fear prevents many patients from obtaining dental care, whether it is fear of dental treatment, local anesthesia, or past dental experiences. Local anesthetics cause stinging and burning upon injection, which may adversely affect fearful patients.

Anesthetic buffering is an option to help relieve stinging and burning upon injection. In the past, the benefits of anesthetic buffering were well documented in medicine.4-6 Recently, anesthetic buffering has been provided as an option for use in dentistry by using a mixing pen and cartridge connectors at chairside to provide an automated way to adjust the pH of an anesthetic cartridge immediately prior to injection.

Remember that local anesthetics used in dentistry are weak bases, and are combined with an acid to form a salt (hydrochloride salt) to render them water-soluble, which creates a stable injectable anesthetic solution. The addition of this hydrochloric acid creates undesirable qualities such as stinging and burning upon injection, relatively slow onset of action, and unreliable or no anesthesia when injected into infected tissues.

Buffering of local anesthetics has been introduced into dentistry to counteract these undesirable qualities. Anesthetic buffering provides the practitioner a way to neutralize the anesthetic immediately before the injection in vitro (outside of the body) rather than the in vivo buffering process, which relies on the patient's physiology to buffer the anesthetic. The buffering process uses a sodium bicarbonate solution that is mixed with a cartridge of local anesthetic such as lidocaine with epinephrine. The interaction between the sodium bicarbonate (NaHCO3) and the hydrochloric acid (HCL) in the local anesthetic creates water (H2O) and carbon dioxide (CO2), which brings the pH of anesthetic solution closer to physiologic.








Figure 2: Example of nonsurgical periodontal therapy care plan with anesthesia for treatment of two quadrants in one appointment. (From Logothetis. Local Anesthesia for the Dental Hygienist, Elsevier, 2012)



Bringing the pH of the anesthetic toward physiologic before injection may improve patient comfort by eliminating the sting, may reduce tissue injury, may reduce anesthetic latency, and may provide more effective anesthesia in the area of infection. Thus, dental hygienists can increase patient comfort by buffering local anesthetics prior to injection.



How can I be less nervous giving a posterior superior alveolar block on my patients? I do not want to give them a hematoma, so I am using infiltration instead.



The posterior superior alveolar block (PSA) is used to achieve pulpal anesthesia in the maxillary third, second, and first molars. The target area is the posterior superior alveolar nerve as it enters the maxilla through the posterior superior alveolar foramina on the maxilla's infratemporal surface, which is at the height of the mucobuccal fold at the apex of the maxillary second molar (see Figure 1).9

Of course, for a patient with a blood-clotting disorder, local anesthetic injection techniques that pose a greater risk of positive aspiration such as the PSA block should be "avoided in favor of supraperiosteal and periodontal ligament injections, or other techniques that do not pose a threat of excessive bleeding."2 But if the patient has no overlying medical risk for bleeding, the clinician has the option of varying the depth of the needle in this area for this block to avoid complications such as a "nonesthetic" hematoma in the infratemporal fossa, a bluish-reddish extraoral swelling of hemorrhaging blood in the tissue on the affected side of the face in the infratemporal fossa that develops a few minutes after the injection, progressing over time inferiorly and anteriorly toward the lower anterior region of the cheek.

This complication can occur if the needle is advanced too far distally into the tissue during a PSA block so that the needle penetrates the pterygoid plexus of veins and the maxillary artery.9 This is a basic risk of local anesthesia; however, care must be taken to avoid this situation.

The current educational method taught in most dental professional programs, and which students are tested on in examinations, is to use a depth of needle penetration at 16 mm or less, which is three-fourths the depth of a short 25-gauge needle.1,2 In addition, clinicians recommend performing "aspiration several times within different planes before administration to reduce risk and to further reaspirate if there is any movement of the needle within the tissue."2

However, a more conservative insertion technique may be considered that is being used by clinicians with proven success so as to reduce risk of hematoma formation. This means going to less depth into the mucobuccal fold at 5-10 mm, which is only one-fourth the depth of the short needle.2 Studies are expected to be completed soon that show this conservative administration method to be successful in placing the agent near the posterior superior alveolar foramina. Remember, using a block instead of infiltration allows for more effective treatment and less discomfort for the patient.



Can I safely give a full-mouth numbing for complete calculus removal in one appointment?



First, it is important to note that gross scaling where large-sized supragingival calculus is removed at the initial appointment is no longer recommended. Instead, two types of periodontal therapy can be considered for patient care during Phase 1 periodontal therapy (nonsurgical phase). Full-mouth debridement is a newer procedure where calculus is removed in a single appointment or more commonly now in two appointments within a 24-hour period, sometimes with the aggressive use of antimicrobial agents for full-mouth disinfection (FMD).10

The more traditional approach is nonsurgical periodontal therapy (NSPT). Studies have shown that "the modest differences in clinical parameters in comparing healing after one session or multiple sessions were not clinically significant."11 In addition, microbial parameters were not significantly different after eight months, regardless of treatment.12

Until evidence indicates otherwise, the sequence and duration of appointments for periodontal therapy should be determined by the clinician based on amount of disease present and the patient's systemic health as well as comfort, and not patient preference or insurance needs. However, staged therapy permits "the advantage of evaluating and reinforcing oral hygiene care," which is key to the effectiveness of Phase 1.3








Figure 3: Target area of the anterior middle superior alveolar block is at the apices of maxillary premolars on the hard palate, midway between the median palatal raphe and lingual gingival margin. Possible distribution is highlighted (purple), but only a variable level of depth and duration that does not meet the complete needs for periodontal therapy by the dental hygienist. (From Fehrenbach, Herring. Illustrated Anatomy of the Head and Neck, 4 ed, Saunders, 2012)



So whether performing FMD or NSPT, the dental hygienist should carefully determine "the extent of periodontal involvement, and how much of the treatment can be realistically accomplished in one visit.2 Local anesthesia use is based on many factors (not listed in importance) such as limited pocket access and topography, tissue tone, root anatomy, hemorrhage risk, as well as the patient's pain threshold and sensitivity.3 Even when using ultrasonics, local anesthesia should be given prior to use with high power to ensure that the patient is comfortable.13

For dental hygienists who are prohibited by state law from administering local anesthesia who may be tempted to start scaling heavy calculus with thin tips on low power to increase patient comfort, experts have noted a burning of heavy calculus into smooth veneers, visible only with a dental endoscope or during open-flap surgery but still able to serve as an "ideal breeding ground for biofilm."14 Thus, local anesthesia should only be administered in the areas of treatment that can be completed in one visit. Overestimating the treatment and administering more anesthesia than necessary should be avoided.2

More importantly, any performance of successful periodontal debridement, whether FMD or NSPT, requires the complete removal of any clinically detectable calculus. Calculus removal is critical to the success of periodontal therapy because calculus retains dental biofilm. Also, there will probably never be one simple standard for assessing the clinical endpoint because the patient's systemic health, immune response, and self-care practices influence healing. Sound professional judgment must be practiced "to determine endpoints of periodontal therapy. Intentionally leaving detectable calculus, therefore, constitutes unethical or substandard care."3

However, the dental hygienist should avoid administering local anesthetics to both the mandibular right and left quadrants during a single treatment to prevent the inability of the patient to control his or her mandible; thus the use of quadrant or half-mouth procedures is usually recommended (see Figure 2). Clinicians report that patients have a hard time swallowing, and replacement of any removable prosthetics or eating soon after can cause gagging. Also, when designing the dental hygiene care plan, the dental hygienist must consider the amount of anesthetic needed to complete the procedure so that they are always staying within the patient's MRD (see earlier question on dosage).15 In addition, administering bilateral inferior alveolar nerve blocks also increases the possibility of the patient causing self-mutilation of their soft tissue.9



There is some discussion about using the AMSA on patients for periodontal therapy. Should I consider it?



The anterior middle superior alveolar (AMSA) block can be used for anesthesia of the periodontium and gingival tissue covering a large area that is normally innervated by the anterior superior alveolar (ASA), middle superior alveolar (MSA), greater palatine (GP), and nasopalatine (NP) blocks in the maxillary arch (see Figure 3). Thus, with a single-site palatal injection, one can anesthetize multiple teeth (from the maxillary second premolar through the maxillary central incisor) and associated periodontium without causing the usual collateral anesthesia to the soft tissue of the patient's upper lip and face. That is why it is commonly used when performing cosmetic dentistry procedures, because after the procedures are completed, the clinician can immediately and accurately assess the patient's smile line.

It is also important to remember that the posterior superior alveolar block (PSA) must still be administered to allow for pulpal anesthesia in the maxillary third, second, and first molars.2

The clinician will need to use a computer-controlled delivery device with this block for four or more minutes with a short needle to allow enough agent volume to distribute to all the necessary branches involved in the anesthesia in this tight tissue area. Said diffusion will take about as long. This was the standard method used in the original research of the block because the device regulates the pressure and volume ratio of solution delivered, which is not readily attained with a manual syringe.16,17 In fact, most past studies concerning this block have been done with these devices since the block was discovered while developing the device.

Thus, it is not true that only a minimal volume of local anesthetic is necessary to provide pulpal anesthesia from the maxillary central incisor to the maxillary second premolar on the side of the injection, but instead one must deposit "a sufficient volume of local anesthetic (that) allows it to diffuse through nutrient canals and porous cortical bone on the palate..."1 Further, any related discussion of what some have conjured up as a "subneural" dental plexus deep to the major branches of the maxillary nerve that is supposed to respond to anesthesia is not truly present according to master anatomists.9 Instead, the major branches of the maxillary nerve act together as dental plexus and respond as such to anesthesia in the area.

Practiced clinicians know already how hard it is to place even the necessary smaller amounts of agent during the GP and NP blocks using a manual syringe. Still, some clinicians think they can use a manual syringe with the AMSA, but it would mean reinjecting the agent multiple times and possibly causing overblanching the tissue, leading to postoperative tissue ischemia and sloughing. A recent study using a manual syringe demonstrates the difficulty of administering enough volume.18 The added cost of this anesthetic delivery system is one potential drawback of the AMSA block.

However, even after depositing a large enough amount of agent using the computer-controlled delivery device, studies show that due to the extensive anatomy involved, the block may be variable in depth and duration of anesthesia, which may compromise its use for nonsurgical periodontal therapy. NSPT usually requires full depth (pulpal of quadrant) and long duration of anesthesia (more than 60 minutes) to complete the treatment.18,19

Some past articles on this block are overly optimistic about the time of administration (only two minutes) and diffusion (only two minutes) as well as length of duration (as long as 90 minutes), which does not serve the practicing clinician well. Attempts to speed up the AMSA block may lead to increased patient discomfort at the injection site.20

Again, recent studies showed a "duration of pulpal anesthesia was gradually declining during the 60 minutes; we cannot confirm the clinical impression of the authors that there is duration of pulpal anesthesia for 60 minutes."18

It is important to note that the initial study using this injection with the computer-controlled delivery device for scaling and root planing was small (20 subjects, split-mouth design) and relied on subjective responses from patients on depth of anesthesia using "visual analog scales and verbal ratings."21 One of these studies using an electric pulp tester showed only "a 66% anesthetic success in the second premolar, 40% in the first pre-molar, 0% in the canine, 23.3% in the lateral incisor, and 16.7% in the central incisor." Another similar study of the computer-controlled delivery device reported successful pulpal anesthesia ranged "from 35% to 58%, and for the manual syringe even lower rates from 20% to 42%."18,19 It is hard to argue for the AMSA block with those lowly numbers.








Figure 5: Horizontal approach at 8 or 9 o'clock, right side by right-handed clinician for the incisive block. (From Fehrenbach and Logothetis. Mandibular nerve anesthesia. Logothetis. Local Anesthesia for the Dental Hygienist, Elsevier, 2012)



Other studies noted cases of short-lived anesthesia in the maxillary central incisor region.20,22 Thus, the nature of the palate does not always allow penetration from the palatal to the facial in order to provide pulpal anesthesia, especially to the faraway maxillary central incisor. Possibly additional facial infiltration can be performed to ensure complete coverage of the quadrant, or even reinjection with another AMSA block when anesthesia is inadequate, but that reduces the positive impact of fewer injections that the AMSA promises.

In addition, these past articles made no mention of the less-than-stellar hemostatic control of the quadrant's overall gingival tissue as later studies confirmed. These studies only demonstrated hemostatic control with the palatal tissue, making it an excellent block for graft harvesting, and with no vasoconstrictor affecting the facial gingiva, outstanding blood supply is maintained for nourishment after the placement of the connective tissue graft.18,20

Instead, reliance on the traditional blocks for the maxillary arch may allow the dental hygienist to treatment plan instrumentation in either quadrants or within sextants with more confidence of pain and hemostatic control.2



I heard about a new technique for giving the incisive block on my patients. How does it work?



The incisive block anesthetizes the pulp and periodontium of the mandibular teeth anterior to the mental foramen, usually the mandibular premolars and anteriors, as well as the facial gingiva. One indication for the use of this block is for NSPT on the mandibular anterior sextant.

However, the incisive block does not provide lingual soft-tissue anesthesia of the anesthetized teeth; an additional supraperiosteal injection may be indicated for localized lingual soft-tissue anesthesia and/or hemostatic control. Since bilateral inferior alveolar (IA) blocks are usually not recommended and IA blocks can even fail, the bilateral use of the incisive block and respond with a range of cost based on the treatment plan that has been created.



The response could sound like this: "Jane, that's a great question. Based on what the doctor recommended, the cost is approximately $3,200. Before you leave, I'm going to introduce you to Kim. Kim is our treatment coordinator, and she can give you all the details on what your insurance will contribute and options for working out your portion of the cost."



Being able to confidently share fees adds another layer to the value you're building for the treatment. When a team member avoids answering the patient's direct question about cost, doubt starts to set in. Having payment options is absolutely essential. They should be clear, written, and consistent, so every person in the practice is able to talk about them with patients.



Even if the patient doesn't specifically ask how much needed dentistry is going to cost, more than likely they are thinking about it. In this situation, the hygienist can save the patient worry by saying, "I see the doctor has recommended this crown on the upper right. After we're done here, I'll take you to talk with Kim, our treatment coordinator. Kim will find out what benefit your insurance may provide and then discuss payment options for your portion." An informed practice means an informed patient -- presenting them with options, information, and assurance that the practice will do everything possible to make it easier for them to get care.



As confident as you are about your doctor's clinical recommendations, it's just as important that you are confident that your administrative team can find a comfortable financial arrangement for your patients who need care. This takes clear, consistent communication between the administrative and clinical team.



Today's hygienist is much more than "the person who cleans teeth." It's up to us as hygienists to step out of our comfort zone and into the role of health-care provider. With a strong, confident administrative team handling the financial options, clinicians can focus on helping patients get the care they need and support the practice in delivering the best care possible.



As the founder of Inspired Hygiene, Rachel Wall, RDH, BS, serves the dental community as a hygiene consultant and speaker. Inspired Hygiene is committed to helping dentists tap into hygiene's profit potential through coaching, webinars, and mastermind groups. In addition to private coaching, Rachel draws from her 20-plus years of experience as a hygienist and practice administrator to deliver clinical articles and speaking programs. She has spoken to numerous groups, including RDH Under One Roof, the AACD Annual Session, and the Hinman Dental Conference. Rachel has written for many dental journals. Inspired Hygiene's programs include private in-office coaching, a free weekly e-zine, the Hygiene Profits Mastermind group, and the Profitable Perio Online Workshop. For more information, visit www.InspiredHygiene.com.

Demetra Daskalos Logothetis, RDH, MS, is emeritus professor and program director at the University of New Mexico Department of Dental Medicine, and currently visiting professor and graduate program director in the university's Division of Dental Hygiene. Demetra has been a professor at the University of New Mexico for 28 years, and served as the dental hygiene program director for 16 years. She has been teaching local anesthesia for 19 years, and is the author of "Local anesthesia for the Dental Hygienist," (Elsevier, 2012) that received honorable mention at the 2013 PROSE awards. This textbook is exclusively related to local anesthesia for the practice of dental hygiene.

Margaret J. Fehrenbach, RDH, MS, is an oral biologist and dental hygiene educational consultant. Margaret recently received the AC Fones Award from ADHA (2013) for her work in promoting local anesthesia for dental hygienists, such as "Local anesthesia for the Dental Hygienist" (Elsevier, 2012) as well as the ADHA Award of Excellence (2009) for her textbook contributions. She is the primary author of the "Illustrated Anatomy of the Head and Neck" (Elsevier, ed 4, 2012) and "Illustrated Dental Embryology, Histology, and Anatomy" (Elsevier, ed 4, 2015) as well as a contributor to "Oral Pathology for Dental Hygienists" (Elsevier, ed 6, 2104) and editor of the "Dental Anatomy Coloring Book" (Elsevier, ed 2, 2013). Margaret has presented at ADEA, ADHA, and ADA Annual Sessions as well as Under One Roof for RDH Magazine. She is now involved in webinars and radio broadcasts as well as social media outlets. She can be contacted through her webpage at www.dhed.net.



References



1. Malamed SF. Handbook of Local Anesthesia. 6 ed, Mosby, 2012.

2. Logothetis. Local Anesthesia for the Dental Hygienist. Elsevier, 2012.

3. Darby, Walsh. Dental Hygiene: Theory and Practice. 3 ed, Saunders, 2010.

4. Bowles, Frysh, Emmons. Clinical evaluation of buffered local anesthetic. General Dentistry. 43(2), 182, 1995.

5. Stewart, Cole, Klein. Neutralized lidocaine with epinephrine for local anesthesia. Journal of Dermatological Surgery in Oncology. 15(10), 108, 1989).

6. Malamed SF, Tavana S, Falkel M. Faster onset and more comfortable injection with alkalinized 2% lidocaine with epinephrine 1:100,000. Compend Contin Educ Dent, 2013, Feb: 34, Spec No 1: 10-20.

7. Logothetis D. Anesthetic buffering: New advances for use in dentistry. RDH, January 2013.

8. Logothetis D. Local anesthetic agents: A review of the current options for dental hygienists. Journal of the California Dental Hygienists' Association, Summer 2011.

9. Fehrenbach, Herring. Illustrated Anatomy of the Head and Neck, 4 ed, Saunders, 2012.

10. Perry, et al. Periodontology for the Dental Hygienist, 4 ed, Saunders, 2014.

11. Newman, et al. Carranza's Clinical Periodontology, 11 ed, Saunders, 2012.

12. Rethman J. Is full-mouth disinfection right for your practice? Dimensions of Dental Hygiene. November 2008.

13. Pattison A. Using thin ultrasonic tips on high power. Dimensions of Dental Hygiene. April 2009.

14. Pattison A. Manage your patients' pain. Dimensions of Dental Hygiene. April 2011.

15. Fehrenbach M. Pain control for dental hygienists: Current concepts in local anesthesia are reviewed. RDH, February 2005.

16. Bath-Balogh, Fehrenbach. Illustrated Dental Embryology, Histology, and Anatomy. 3rd ed, Saunders, 2011.

17. Loomer, Perry. Computer-controlled delivery versus syringe delivery of local anesthetic injections for therapeutic scaling and root planing. Journal of the American Dental Association. 135(3):358-65, 2004.

18. Velasco, Reinaldo. Anterior and middle superior alveolar nerve block for anesthesia of maxillary teeth using conventional syringe. Dental Research Journal. 9(5): 535–540, 2012.

19. Lee, et al. Anesthetic efficacy of the anterior middle superior alveolar (AMSA) injection. Anesthesia Progress. 51(3):80-9, 2004.

20. Alam, et al. AMSA (Anterior Middle Superior Alveolar) injection: A boon to maxillary periodontal surgery. Journal of Clinical and Diagnostic Research. 5:675-678, 2011.

21. Perry, Loomer. Maximizing pain control: The AMSA injection can provide anesthesia with fewer injections and less pain. Dimensions of Dental Hygiene. 1: 28-33, 2003.

22. Corbett, et al. A comparison of the anterior middle superior alveolar nerve block and infraorbital nerve block for anesthesia of maxillary anterior teeth. Journal of the American Dental Association. 141(12):1442-8, 2010.

23. Fehrenbach. The horizontal incisive block underutilized but ultimately useful. Journal of the California Dental Hygienists' Association, Summer 2011.



Source: http://www.rdhmag.com/articles/print/volume-34/issue-6/features/local-anesthesia-options-during-dental-hygiene-care.html



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• Thu, 11:27 : New series aims to inform dialogue on dental health http://t.co/17riRjBiMl


• Thu, 11:45 : http://t.co/WFEBj2Z1ki New series aims to inform dialogue on dental health

from paul_fjeldsted http://paul-fjeldsted.livejournal.com/24782.html

New series aims to inform dialogue on dental health

Oregon is in an oral health crisis



That's what a source of mine told me about a month ago. The story she helped me tell in May was a sobering one.



An estimated 77 people per day go to an Oregon emergency room to receive dental care, many because they lack access to routine and preventive care, according to a study commissioned by the Oral Health Funders Collaborative. The hospital emergency room is the highest cost place of care, but it doesn't always provide the best care.



For $8 million annually, hospitals generally will give oral health patients antibiotics and painkillers then advise them to follow up with a dentist. But considering they ended up in the ER due to hurdles barring patients from accessing dentists in the first place, a quarter of the time, they will return to the ER for the same problem.



Meanwhile, oral pain inhibits people's ability to eat, work, care for their children and learn in school. It invades every aspect of life.



Private stakeholders and the state government have both decided it's time for change. And as a reporter, it was important for me to bear witness to these efforts on your behalf. This is why, on Monday, we launched a new occasional series called Oregon's Oral Exam.



This isn't going to be an easy task. There needs to be a solution on what to do about the shortage of dentists and how to make treating under served populations financially rewarding. There are questions of new training paths and how to instill good oral hygiene habits to young children.



As the Oral Health Funders Collaborative works on its strategic plan on oral health and the Oregon Health Authority starts overseeing pilot projects targeting this issue, we'll be there to help inform the public dialogue.



Here are some aspects I'm hoping to get a closer look at:



Lives impacted



Like most other social and health issues, low-income Oregonians are disproportionately affected by this systemic problem.



Uninsured people are eight times more likely to to visit the ER for dental problems, and Medicaid patients were four times more likely compared to commercially insured people.



Because it's so difficult finding dentists willing to see Medicaid patients and paying out of pocket is unaffordable for the uninsured, the ER becomes the default care setting that guarantees treatment.



In addition, tooth decay is the most common chronic condition in children with many of them going untreated.



The financial burden



Until recently, dental health benefits in the Oregon Health Plan was in flux. If the state budget needed some relief, it was the benefit that was compromised.



It wasn't until 2014 that dental health benefits were restored beyond emergency care, so it will be interesting what coordinated care organizations do to address the new demand.



If we don't figure out a way to take care of people's teeth in low-cost, preventive and routine settings, evidence shows we will be paying through higher cost, less effective care, not to mention the cost to quality of life.



The professional shortage



It has been a while since the medical field began acknowledging that we need mid-level providers like nurse practitioners to perform at the top of their training to help expand access to care. It was a cultural shift, as we began distributing the workload off the overburdened shoulders of medical doctors.



The same question has emerged in dentistry, with dental therapists being authorized to practice in Minnesota, Maine and tribal communities in Alaska. Dental therapists provide a range of routine services like drilling and extracting teeth.



However, this too, will take a shift in mindset. The American Dental Association contends that only dentists should be able to perform irreversible surgical procedures.



As I cover this topic over the next few months, please help us by pointing me to story ideas and sources.



Source: http://www.statesmanjournal.com/story/news/health/2014/06/30/new-series-aims-inform-dialogue-dental-health/11810499/



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• Tue, 11:11 : Oil pulling for oral health: Fad or fabulous? http://t.co/0kohHRamhQ


• Tue, 11:22 : http://t.co/qSGCKOeKNl Oil pulling for oral health: Fad or fabulous?

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Oil pulling for oral health: Fad or fabulous?

I like to stay ahead of the curve. So when I hear about a procedure or a product that is new, I'm not likely to put it down. I get curious, knowing that some new things can be good. Most every doctor has some level of interest in something new. But we all look to see if the risks are worth the rewards and then make our recommendations accordingly.



But when we doctors are not sure what to say to a patient who has read an article or seen a news story that is the "latest thing," we all do the same thing. We go to the dental or medical literature.



The website that we go to is a National Library of Medicine website called Pubmed.gov. There we find abstracts of every article published in medical journals. We can see what's been written about the procedure or product. It's where we get some objectivity, as we can see how monitored trials using that procedure or product came out. Often, these trials are done using controls, so we can see data that compares the experimental group and the control group. You can go there, too.



So when, Bob, who has been a loyal patient and friend for many years, sent me an article on the Internet on "oil pulling," I was intrigued. I had heard about oil pulling from another patient a couple of years ago. She had tried it for her periodontal disease and it hadn't worked, so she decided to see me. Oil pulling has been part of Ayurvedic medicine for years. That's likely a good thing.



Now, all I hear about is "oil pulling." It was on TV this weekend. It's all over the Internet. It was in this section a few weeks ago. It is the latest thing, even though it was proposed thousands of years ago in India. I hear a doctor talking about how swishing coconut oil in the mouth will not only improve oral health, it will help general health. He says that it will remove dental abscesses, and I'm sitting there stunned, because it makes no sense to me.



I look on Pubmed.gov. I see nearly nothing about oil pulling and dental disease, but a couple of articles at least show that oil will emulsify if left in the mouth for 20 minutes and that there is at least a mild antibacterial effect as good as chlorhexidine when studied in the laboratory. So, at least there is some literature, but chlorhexidine won't treat abscesses.



So what's my next step? I bought some coconut oil and swished it around my mouth for 20 minutes. I didn't feel that I had to swallow. It tasted pretty good, too. So, I'm buying the book, will read it on vacation, just to see what the author says. And I'll likely tell my most periodontally resistant patients about oil pulling, that it's likely harmless, and see what happens. I'll get back to you.



Dr. Lee Sheldon has a dental implant and periodontal practice in Melbourne. He is a featured guest on "Focus on Seniors" on WMEL radio. He also serves as vice president of the advocacy group, Helping Seniors of Brevard County. He is the author of the book, "The Ultimate Mouth Manual," available at all bookstores.



Source: http://www.floridatoday.com/story/life/wellness/2014/07/03/oil-pulling-oral-health-fad-fabulous/12013131/



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• Thu, 10:33 : Does Running Lead to Worse Oral Health? http://t.co/oRhARA8AAg


• Thu, 10:43 : http://t.co/2ADxfrZHDL Does Running Lead to Worse Oral Health?

from paul_fjeldsted http://paul-fjeldsted.livejournal.com/22694.html

Does Running Lead to Worse Oral Health?

New research shows that carbs, altered saliva flow can harm teeth.

Aside from overuse injuries and skin cancer, runners score well on most measures of good health. But another red flag has been raised by new research: Runners may suffer higher risks of tooth erosion and cavities.



In the Scandinavian Journal of Medicine & Science in Sports, a team of German dental researchers report significantly higher tooth erosion in triathletes than in non-athletes. In addition, the researchers found that athletes who engaged in more weekly training had more cavities than those who trained less.



“The triathletes’ high carbohydrate consumption, including sports drinks, gels, and bars during training, can lower the mouth’s pH below the critical mark of 5.5,” Cornelia Frese told Runner’s World Newswire. “That can lead to dental erosion and caries. Also, the athletes breathe through the mouth during hard exercise. The mouth gets dry, and produces less saliva, which normally protects the teeth.”



Frese, a marathoner, is a researcher in the Department of Conservative Dentistry at the University Hospital in Heidelberg, Germany. She and her husband, triathlete Falko Friese, were part of a team that investigated the dental health of 35 triathletes who trained almost 10 hours a week with a mix of cycling, running, and swimming. The athletes were examined for cavities and tooth erosion. They also took a saliva test both at rest and while exercising. All results were compared to the control group.



Both groups had an average age of 36, but the athletes were significantly lighter, with lower BMIs. This leanness is known to correlate with many positive health outcomes.



From a questionnaire, the researchers learned that 46 percent of the athletes consumed sports drinks while training, and 51 percent water. Seventy-four percent used gels or bars.



Results from the various dental tests revealed no statistically significant difference in cavities between the two groups, although the athletes who trained the most had the most cavities. Type of sports beverage consumed was also not linked to cavities. However, there was a highly significant difference in tooth erosion, with the athletes having more.



At rest, members of the two groups had similar saliva profiles. However, when they began exercising, the athletes produced less saliva and it was acidic (i.e., pH lower than 7). Also, the degree of acidity increased with the length of time exercising. The exercise test given to the athletes lasted just 36 minutes on average. Saliva is considered important to good tooth health.



“Based on these findings, it can be suggested that endurance training has detrimental effects on oral health,” the researchers write. “Additionally, there is a need for exercise-adjusted oral hygiene regimes and nutritional modifications in the field of sports dentistry.”



Cornelia Friese told Newswire that her team is looking into possible modifications. “We are conducting a randomized, controlled clinical trial with 55 endurance athletes to test special toothpastes and mouth rinses," she said. "If we could find a superior product that athletes can apply before training, that would be the ideal prevention.”



Until then, it would seem prudent to brush your teeth following a run, particularly if you have consumed various carbs during the run or after it.



Source: http://www.runnersworld.com/health/does-running-lead-to-worse-oral-health



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• Wed, 10:33 : Poor Dental Health Increases Mortality Risk in ESRD Patients http://t.co/O6f6cmGhed


• Wed, 10:34 : http://t.co/gQ8X09gwQU Poor Dental Health Increases Mortality Risk in ESRD Patients

from paul_fjeldsted http://paul-fjeldsted.livejournal.com/22098.html

Poor Dental Health Increases Mortality Risk in ESRD Patients

AMSTERDAM — Poor dental health is independently associated with a higher risk for all-cause and cardiovascular mortality in hemodialysis patients with end-stage renal disease (ESRD), new research shows. And good oral hygiene is independently associated with better overall survival.








"Dialysis patients die at an excessive rate, compared with the general population," said Giovanni Strippoli, MD, PhD, senior vice president of scientific affairs and chair of the Diaverum Academy in Sweden.



"Basically, no drug seems to work that well for them, so we have to look at other potentially treatable factors," he told Medscape Medical News.



"Our general finding was that dialysis patients who had either no teeth or bad teeth had a higher risk of all-cause mortality than those who did not, and the adjusted risk of cardiovascular mortality followed a similar pattern," he explained.



Dr. Strippoli presented findings from the Oral Diseases in Hemodialysis (ORAL-D) study here at the European Renal Association-European Dialysis and Transplant Association 51st Congress.



ORAL-D Study



The prospective cohort study involved 4320 adults with ESRD randomly selected from European outpatient dialysis clinics administered by Diaverum, a kidney services provider.



At baseline, dental surgeons with training in periodontology and oral diseases assessed the oral health of all participants. Oral hygiene habits were evaluated using self-administered questionnaires.



Total and cause-specific data for hospitalizations and mortality were analyzed.



At a median follow-up of 22.1 months, 650 participants had died from any cause and 325 had died from a cardiovascular event.



For the 23% of the subjects with no teeth, the hazard ratio for all-cause mortality, after adjustment for multiple potential confounders, was 1.27.



For the subjects with more than 14 decayed, missing, or filled teeth, the hazard ratio for all-cause mortality was 1.46.



Patients with good dental hygiene had better overall survival.



"When you go into dialysis clinics, you see that patients have terrible teeth, among other conditions," said Dr. Strippoli. "One day, I thought, why don't we look into this, because the association between dental health in ESRD patients and mortality was unknown," he explained.



In a recent meta-analysis of ESRD patients, Dr. Strippoli's team found that one-quarter of patients never brushed their teeth, and only a minority ever flossed (Nephrol Dial Transplant. 2014;29:364-375). This might explain why oral disease is more severe in dialysis patients than in the population overall.



The association between poor dental health and increased mortality risk suggests that improved oral hygiene would improve survival in ESRD patients, Dr. Strippoli said, and it certainly couldn't do any harm.



This is a "simple but important observation," said Lynda Anne Szczech, MD, from Durham Nephrology Associates in North Carolina.



ORAL-D confirms findings from a previous study of ESRD patients. Those researchers found a significant association between moderate to severe periodontal disease and cardiovascular mortality, she reported.



"Inflammation is a powerful force that we are just beginning to recognize," Dr. Szczech told Medscape Medical News.



"The key is knowledge and action," she said. "And the role of good dental health in people with normal or abnormal kidney function is such an 'actionable' area."



Proper randomized trials are still needed, said Massimo Petruzzi, DDS, PhD, assistant professor of dentistry at the University of Bari in Italy. Nevertheless, this study "certainly strongly suggests that dental care should be provided for hemodialysis patients," he added.



The study was funded by Diaverum. Dr. Strippoli, Dr. Szczech, and Dr. Petruzzi have disclosed no relevant financial relationships.



European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) 51st Congress: Abstract 4054. Presented June 1, 2014.



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